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The article will examine the role of the Medical Officer of Health within United Kingdom Local Authorities in the period preceding the Second World War, the war itself, the residual impact of their work on emergency medical and public health practice and lessons that can be learned to improve. The article uses archival and secondary source analysis of documents related to the work of the Medical Officer of Health, their staff, and associated organisations. The Medical Officer of Health performed a key role in the Civil Defence of the United Kingdom, ensuring that the victims of aerial bombardment were treated quickly. They also worked to ensure the public health of the population was maintained, especially those covering areas receiving evacuees, and worked to improve conditions within deep shelters and other areas with displaced individuals. The work of the Medical Officer of Health created the forerunner of modern emergency medical practice in the United Kingdom, often through local innovation, and embedded the work on health promotion and protection fulfilled by Directors of Public Health. [ABSTRACT FROM AUTHOR]

The rapid evolution of technology and a large number of smartphone users are transforming the way the masses access financial services. Fintech companies consistently innovate in developing customized products and services for users and SMEs to increase financial access and inclusiveness to achieve the Indonesian national financial inclusion target of 90 percent by 2024. Access to digital financial products via Fintech contributes to greater financial inclusion for SMEs, particularly during the COVID-19 pandemic, which restricted economic activities. Using an extended TAM model, this study explores the driving factors of Fintech adoption for Indonesian SMEs during the COVID-19 outbreak. Data analysis of 415 respondents was conducted utilizing Smart-PLS 3.0 software. The findings confirm perceived usefulness, perceived ease of use, government support, trust, and user innovativeness to have a direct positive effect on the intention of SMEs to adopt Fintech. The result also reveals that financial literacy indirectly correlates with Fintech adoption mediated by user innovativeness. This indicates that Fintech could contribute to bridging financial inclusion where SMEs with lower financial literacy can utilize financial products and services via Fintech. This is a positive contribution of Fintech for SMEs in developing economies. The present study suggests that policymakers could foster the expansion of Fintech business infrastructure to improve access to SME financial services. [ABSTRACT FROM AUTHOR]

The explosion of mobile health and portable obstetric ultrasound interventions in low- and middle-income countries (LMIC) reflects the optimism that technology can help reduce persistently high rates of maternal and neonatal mortality and morbidity in these settings. While these technology-driven interventions have had success in improving aspects of antenatal and perinatal care, they have not clearly demonstrated reductions in mortality. The expanding synergy between mobile health (mHealth) and ultrasound technology shows promise to enhance care, but it will likely take combining these technological advances with system-wide approaches that also address referral patterns and infrastructure barriers to improve outcomes. [ABSTRACT FROM AUTHOR]

Background The safety of long-acting β-agonists added to inhaled corticosteroids for the treatment of persistent asthma has been controversial. Objective We sought to determine whether administering formoterol in combination with mometasone furoate increases the risk of serious asthma outcomes (SAOs) compared with mometasone furoate alone. This clinical trial is registered as NCT01471340. Methods We conducted a 26-week, randomized, double-blind trial in adolescent and adult patients (≥12 years) with persistent asthma in 35 countries with the primary objective of evaluating whether mometasone furoate–formoterol increases the risk of SAOs (adjudicated hospitalization, intubation, or death) compared with mometasone furoate alone. The key efficacy end point was asthma exacerbation (composite of hospitalization of ≥24 hours, emergency department visits of <24 hours requiring systemic corticosteroids, or use of systemic corticosteroids for ≥3 consecutive days). Results Among 11,729 patients (mometasone furoate–formoterol, n = 5,868; mometasone furoate, n = 5,861), a total of 81 SAOs, all asthma-related hospitalizations, were observed in 71 patients: 45 events from 39 patients receiving mometasone furoate–formoterol and 36 events from 32 patients receiving mometasone furoate. The hazard ratio for the first SAO in the mometasone furoate–formoterol versus mometasone furoate group was 1.22 (95% CI, 0.76-1.94; P =.411). Asthma exacerbation occurred in 1,487 patients: 708 receiving mometasone furoate–formoterol and 779 receiving mometasone furoate. The hazard ratio for the first asthma exacerbation in the mometasone furoate–formoterol versus mometasone furoate group was 0.89 (95% CI, 0.80-0.98; P =.021). Conclusions The addition of formoterol to mometasone furoate maintenance therapy did not increase the risk of serious asthma-related events and reduced the risk of asthma exacerbation. [ABSTRACT FROM AUTHOR]

This study investigates the volatility and external shock persistence within the financial and alternative assets markets during times of crises triggered by Covid-19 and the war in Ukraine. Univariate GARCH family models are used to capture the effect of financial turmoil caused by recent crises. Five different class of assets (which includes Islamic, ESG, Conventional, Crypto, FinTech, and commodities) have been chosen to represent a sample of the worldwide traditional financial market and alternative assets. The findings of this study revealed that almost all financial and alternative assets experienced an increase in volatility, except Bitcoin, across all observation periods. Islamic stock and ESG indexes exhibited high volatility before the Covid-19 outbreak. During the pandemic, all assets became more volatile. In addition, Islamic equities and ESG indexes showed relatively lower risk compared to conventional stocks and other alternative assets during the war. Multiple financial assets tend to be highly volatile during crises; however, global investors need to consider the advantages of incorporating Islamic stocks and ESG indexes as part of their investment portfolio innovation strategy, particularly in the presence of geopolitical risk. [ABSTRACT FROM AUTHOR]

Prior studies have suggested that obstetrical (OB) ultrasound in low- and middle-income countries has aided in detection of high-risk conditions, which in turn could improve OB management. We are participating in a cluster-randomized clinical trial of OB ultrasound, which is designed to assess the effect of basic OB ultrasound on maternal mortality, fetal mortality, neonatal mortality, and maternal near-miss in 5 low-income countries. We designed a 2-week course in basic OB ultrasound, followed by 12 weeks of oversight, to train health care professionals with no prior ultrasound experience to perform basic OB ultrasound to screen for high-risk pregnancies. All patients with high-risk pregnancies identified by the trainees were referred to higher-level health facilities where fully trained sonographers confirmed the diagnoses before any actions were taken. Although there have been several published studies on basic OB ultrasound training courses for health care workers in low- and middle-income countries, quality control reporting has been limited. The purpose of this study is to report on quality control results of these trainees. Health care workers trained in similar courses could have an adjunctive role in ultrasound screening for high-risk OB conditions where access to care is limited. After completion of the ultrasound course, 41 trainees in 5 countries performed 3801 ultrasound examinations during a 12-week pilot period. Each examination was reviewed by ultrasound trainers for errors in scanning parameters and errors in diagnosis, using predetermined criteria. Of the 32,480 images comprising the 3801 examinations, 94.8% were rated as satisfactory by the reviewers. There was 99.4% concordance between trainee and reviewer ultrasound diagnosis. The results suggest that trained health care workers could play a role in ultrasound screening for high-risk OB conditions. [ABSTRACT FROM AUTHOR]

Background: The Rhinitis Control Assessment Test (RCAT) is a brief, patient-completed tool to evaluate rhinitis symptom control. Objective: We sought to test the reliability, validity, and responsiveness of RCAT and to estimate a cut-point score and minimal important difference (MID). Methods: A total of 402 patients 12 years of age and older with allergic or nonallergic rhinitis were enrolled in a noninterventional study. Patients completed the RCAT (6 items; score range, 6-30) and had Total Nasal Symptom Scores (TNSSs) measured at baseline and 2 weeks later. Physicians completed a global assessment of rhinitis symptom control (Physician''s Global Assessment) and disease severity. Internal consistency, test-retest reliability, convergent validity, known-groups validity, and responsiveness were evaluated. The MID was determined by using distribution- and anchor-based methods. Content validity of the RCAT was assessed in individual interviews with a separate group of 58 adult patients. Results: Internal consistency and test-retest reliability of RCAT scores were 0.77 and 0.78, respectively. Convergent validity correlation between RCAT and TNSS scores was 0.57, and that between RCAT and Physician''s Global Assessment scores was 0.34. Mean RCAT scores differed significantly (P < .001) across patient groups, differing in TNSS (F = 72.7), Physician''s Global Assessment score (F = 28.6), and disease severity (F = 34.1) in the hypothesized direction. Results suggested a cut-point score of 21 or less can be used to identify patients who are experiencing rhinitis symptom control problems. The preliminary estimate of the MID was 3 points. Patients found RCAT items comprehensive, easy to understand, and relevant. Conclusion: The RCAT demonstrated adequate reliability, validity, and responsiveness and was deemed acceptable and appropriate by patients. This tool can facilitate the detection of rhinitis symptom control problems, and its brevity supports its usefulness in clinical care. [Copyright &y& Elsevier]

Abstract: Background: Nasal congestion is a cardinal symptom of allergic rhinitis (AR). It is difficult to treat and is associated with decreased quality of life. Objective: This article reviews the clinical features of nasal congestion, its complex pathophysiology in the context of AR, its clinical impact, and the strengths and weaknesses of available treatments. Methods: Primary studies and reviews in the peerreviewed, English-language literature were identified through searches of MEDLINE (1966–2008) and the Cochrane Library (1996–2008) using the terms nasal congestion, allergic rhinitis, pathophysiology, quality of life, and burden. Additional references were obtained by searching the reference lists of the identified articles. Abstracts from the 2006 and 2007 meetings of the American Academy of Allergy, Asthma, and Immunology were also searched. Pertinent articles were included in the review if they were recently published and patient-focused, and if their authors were recognized leaders in the field. Results: A survey of 2355 patients with AR or their guardians found that almost half of respondents rated nasal congestion the most bothersome symptom; in a survey of 2500 adults with AR, 78% rated nasal congestion either extremely or moderately bothersome. Histamine and leukotrienes are major mediators of the allergic inflammation associated with nasal congestion, as indicated by reductions in nasal cross-sectional area in response to histamine challenge (P < 0.001) and increases in nasal airway resistance in response to leukotriene challenge (P < 0.05).Therapy for nasal congestion in AR is often hampered by limitations associated with the individual agents; for example, decongestants are effective in the control of nasal congestion, but their use is restricted by their adverse-event profiles. A metaanalysis of 16 controlled studies involving 2267 patients with AR found that intranasal corticosteroids provided significantly greater relief of nasal congestion than oral antihistamines (95% CI for combined standardized mean difference, −0.73 to −0.53). The results of several clinical trials have suggested that leukotriene-receptor antagonists may be associated with reduced nasal congestion; however, no agents in this class are currently approved for the treatment of nasal congestion in AR. Conclusion: There is a need for therapies that are well tolerated and effective in relieving nasal congestion in AR. [Copyright &y& Elsevier]

Summary: Background: The twice daily administration of an inhaled corticosteroid (ICS) and long-acting beta2-agonist (LABA) has been shown to be effective in achieving asthma control. The once daily administration of an ICS/LABA may be a treatment option for some patients. Objective: To assess the effectiveness of fluticasone propionate (FP)/salmeterol via a single inhaler (FSC) administered once daily compared with FP once daily, FSC twice daily, or placebo. Methods: A 12-week, randomized, double-blind multicenter study conducted in 844 patients ⩾12 years of age who were symptomatic while using a short-acting beta2-agonist alone. Blinded treatments included: FSC 250/50mcg once daily in the evening (FSC 250/50 QD), FP 250mcg once daily in the evening (FP 250 QD), FSC 100/50mcg twice daily (FSC 100/50mcg BID), or placebo. All treatments were delivered via the Diskus® device. Results: All treatments demonstrated greater improvements in efficacy measures compared with placebo. Overall, the greatest improvements were observed in the patients receiving FSC, either once or twice daily, compared with the FP 250 QD group. The two FSC treatments were similar except that QD dosing did not maintain improvements in lung function for 24h compared with twice daily dosing. All treatments were well tolerated. No suppression of HPA axis, as assessed by 24-h urinary cortisol excretion, was observed in any of the active treatment groups. Conclusion: In patients symptomatic on a short-acting beta2-agonist alone, FSC 100/50mcg BID was shown to provide better efficacy than a higher strength (FSC 250/50mcg) administered once daily. However, a once daily regimen was effective and may be a valuable treatment option for some patients. Registered at http://ctr.gsk.co.uk/welcome.asp (SAS30022) [Copyright &y& Elsevier]

Background: The development of the Asthma Control Test (ACT), a short, simple, patient-based tool for identifying patients with poorly controlled asthma, was recently described in patients under the routine care of an asthma specialist. Objectives: We sought to evaluate the reliability and validity of the ACT in a longitudinal study of asthmatic patients new to the care of an asthma specialist. Methods: Patients (n = 313) completed the ACT and the Asthma Control Questionnaire (ACQ) at 2 physician visits (4-12 weeks apart). Pulmonary function was measured, and asthma specialists rated asthma control. Results: Internal consistency reliability of the ACT was 0.85 (baseline) and 0.79 (follow-up). Test-retest reliability was 0.77. Criterion validity was demonstrated by significant correlations between baseline ACT scores and baseline specialists'' ratings of asthma control (r = 0.52, P < .001) and ACQ scores (r = −0.89, P < .001). Discriminant validity was demonstrated, with significant (P < .001) differences in mean ACT scores across patients differing in asthma control, pulmonary function, and treatment recommendation. Responsiveness of the ACT to changes in asthma control and lung function was demonstrated with significant correlations between changes in ACT scores and changes in specialists'' ratings (r = 0.44, P < .001), ACQ scores (r = −0.69, P < .001), and percent predicted FEV1 values (r = 0.29, P < .001). An ACT score of 19 or less provided optimum balance of sensitivity (71%) and specificity (71%) for detecting uncontrolled asthma. Conclusions: The ACT is reliable, valid, and responsive to changes in asthma control over time in patients new to the care of asthma specialists. A cutoff score of 19 or less identifies patients with poorly controlled asthma. Clinical implications: In a clinical setting the ACT should be a useful tool to help physicians identify patients with uncontrolled asthma and facilitate their ability to follow patients'' progress with treatment. [Copyright &y& Elsevier]

Abstract: Objective:: This study compared the efficacy andtolerability of the combination of fluticasone propionate (FP) and salmeterol (SAL) delivered via a single hydrofluoroalkane (HFA) 134a metered-dose inhaler (MDI) with those of its 2 components alone delivered via a chlorofluorocarbon (CFC) MDI and placebo (PLA) delivered via HFA MDI in adolescent and adult patients with persistent asthma that was not controlled by medium doses (equivalent to FP 440–660 μg/d) of inhaled corticosteroids (ICSs). Methods:: This was a randomized, double-blind,placebo-controlled, parallel-group study consisting of a 2-week, single-blind, placebo run-in period followed by a 12-week, double-blind treatment period. Participants had to be ≥12 years of age and have a diagnosis of asthma requiring pharmacotherapy for at least 6 months before the study. Patients had to have used ICS therapy for ≥3 months before the study and at a consistent dose for the previous month. Lack of asthma control was defined as a forced expiratory volume in 1 second (FEV1) that was 40% to 85% of the predicted value. Patients could not enter the double-blind treatment period if they had 3 days when they required >12 puffs of rescue albuterol per day or >3 nighttime awakenings due to asthma that required treatment with albuterol during the 7 days before the randomization visit. Patients were randomized to receive one of the following treatments delivered via MDI twice daily for 12 weeks: FSC 220/42 μg HFA (2 inhalations of FSC 110/21 μg; 125 μg/21 μg ex-valve); FP 220 μg CFC (2 inhalations of FP 110 μg); SAL 42 μg CFC (2 inhalations of 21 μg); or 2 inhalations of PLA HFA. The primary efficacy end point for FSC versus FP was the mean area under the 12-hour serial FEV1 curve relative to the prerandomization baseline (FEV1 AUCbl). The primary efficacy end points for FSC versus SAL were the mean change from baseline in morning predose FEV1 at end point and the probability of not being withdrawn from the study due to worsening asthma. Tolerability assessments included electrocardiograms, routine clinical laboratory tests, vital signs, oropharyngeal examinations, and physical examinations. Adverse events were assessed at each clinic visit. Results:: Thirty-two adolescent and 333 adult patientswere randomly assigned to receive double-blind treatment. The treatment groups were comparable at baseline with respect to demographic characteristics (mean age, 38–41 years; white race, 78%–88%) and pulmonary function (mean percent predicted FEV1, 68%–69%; mean asthma symptom score, 1.6 [scale 0–5]; and mean daily albuterol use, 3.1 puffs). After 12 weeks of treatment, the mean FEV1 AUCbl was significantly greater in patients who received FSC compared with those who received FP, SAL, or PLA (7.0, 3.6, 5.3, and 1.4 L-h, respectively; all comparisons, P ≤ 0.020). At end point, the mean change from baseline in morning predose FEV1 for FSC was significantly greater than that for FP, SAL, and PLA (0.41, 0.19, 0.15, and −0.12 L; all comparisons, P ≤ 0.001). During 12 weeks of treatment, 7% of patients receiving FSC were withdrawn due to worsening asthma, compared with 24% of patients receiving SAL and 54% of patients receiving PLA (P < 0.001); 11% of patients receiving FP were withdrawn due to worsening asthma. Treatment with FSC resulted in significant improvements in morning and evening peak expiratory flow compared with FP, SAL, and PLA (both, P < 0.001); need for rescue albuterol compared with FP and PLA (P ⩽ 0.005); and asthma symptom scores compared with PLA (P ⩽ 0.001). The tolerability of FSC was similar to that of FP or SAL alone. The incidence of possibly drug-related adverse events was generally similar across treatment groups, and the most common (occurring in ⩾ 2% of patients) were headache (1%–4%), throat irritation (1%–2%), candidiasis of the mouth/throat (0%–2%), unspecified oropharyngeal plaques (0%–2%), and palpitations (0%–2%). Conclusions:: In these adolescent and adult patientswhose asthma was not controlled by medium doses of an ICS, FSC delivered via HFA 134a MDI (2 inhalations of 110/21-μg strength administered BID) was more effective in improving lung function than FP or SAL monotherapy or PLA. All treatments were well tolerated. [Copyright &y& Elsevier]

The integration of the financial industry and financial technology (Fintech) plays a pivotal role in increasing financial services reach and inclusion for the large unbanked population in Indonesia. Fintech adoption optimization expands the financial access to formal financial institutions, especially to vulnerable groups such as the unbanked population who predominantly reside in rural areas far from formal financial institutions. Fintech is viewed as a game changer to bring finance to the unreached communities via information technology and digital financial landscape. In this causal research, data collection was done via online questionnaires to 485 Fintech users between December 2020 and April 2021. Data analysis and path modelling was performed using smartPLS 3.0 software. Result shows user innovativeness as a significant predictor, directly and indirectly affecting the adoption of Fintech in Indonesia, while user attitude found the most important factor towards Fintech adoption. Financial literacy is the least important variable to predict Fintech adoption, contrary to popular belief. This indicates that Fintech usage requires less financial literacy and is potential to reach unbanked population and those with low financial literacy. To make Fintech more inclusive, the government needs to accelerate improving Information and Communications Technology (ICT) infrastructure such as widening mobile broadband penetration and soft infrastructure by encouraging Fintech startup, allowing regulatory sandbox for startups, and driving financial institutions to innovate through Fintech to bring financial services to unbanked population. [ABSTRACT FROM AUTHOR]

These parameters were developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology; the American College of Allergy, Asthma and Immunology; and the Joint Council of Allergy, Asthma and Immunology. The American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI) have jointly accepted responsibility for establishing “The diagnosis and management of sinusitis: a practice parameter update.” This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or the ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma and Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion. [Copyright &y& Elsevier]

• Cheapest electric cooking technology: Solar panel directly powers resistive heater. • Phase Change Thermal Storage (PCTS): power & versatility improves cooking. • More broadly , PTCS may provide solution to solar energy intermittency. • Erythritol: inexpensive, nontoxic, high specific & latent heat. Melts @ 118° C. • Cooking is great application of PCTS, but erythritol degrades after months above 180 °C. A 100 W solar panel directly powering an Insulated Solar Electric Cooker (ISEC) can slowly cook 5 kg of food over the course of a day. However, 0.4 kWh of the day's energy can be stored in 2.5 kg of erythritol phase change material, allowing ISEC to cook more rapidly, as well as cook after sunset. We control supercooling by forcing crystallization, making erythritol an ideal thermal storage material for cooking and other thermal-storage processes, but the erythritol degrades in quality when cycled for several months over 180 °C. The efficiency of thermal storage is comparable to that of more expensive systems using battery storage and induction cooktops. ISECs can be built in low-income communities, and the best design varies depending on availability of materials, access to building technologies, and local preferences. A Global Learning Community of researchers, funding agencies, nonprofits, student groups, and local enterprises is collaboratively developing the open source technology with partners in low income communities to optimize designs, construction, and dissemination. [ABSTRACT FROM AUTHOR]

Abstract Background: There are no published studies that have compared the medical costs of patients with seasonal and perennial allergic rhinitis symptomatology. Objectives: The objectives of this study were to develop an algorithm for classifying patients into seasonal and perennial groups based on their patterns of allergy medication use and then compare the epidemiology and economics of the two groups. Methods: Data for the study were obtained from the 1996 to 1998 MarketScan databases containing linked inpatient, outpatient, and pharmaceutical claims for approximately 2 million covered lives annually. Patients were classified into seasonal allergic rhinitis (SAR) or perennial allergic rhinitis (PAR) groups based on their pattern of allergy medication use over the course of 1 year and then compared using descriptive methods. Results: Seventy-nine percent of the total study sample (80,534 allergy patients) was classified as SAR and 21% as PAR. PAR patients were found to have higher mean levels of allergy-related outpatient payments ($568 vs. $471) and higher mean costs for second-generation antihistamines ($552 vs. $162). PAR patients also had higher levels of comorbidities (asthma, sinusitis, depression, and migraine), higher numbers of concomitant medications (multiple second-generation antihistamines, nasal steroids, other antihistamines, asthma medications, and ophthalmic decongestants), and more immunization encounters. Conclusions: Approximately 21% of allergic rhinitis patients have perennial symptoms as reflected in their patterns of medication use. Perennial patients have significantly higher allergy-related health-care costs and rates of comorbidities and greater use of concomitant medications. These distinct clinical and resource use profiles may have implications for therapy choices in the cost-effective management of perennial allergic rhinitis patients. [ABSTRACT FROM AUTHOR]